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CPR II - EXAM 1 & 2 > Cardiac Pathology > Flashcards

Cardiac Pathology Flashcards

1
Q

What is the most common type of heart disease and leading cause of death?

A

Coronary Artery Disease

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2
Q

Increasing age, Male gender, Hypertension, Hyperlipedemia, Cigarette Smoking & Diabetes are risk factors for what?

A

Coronary Artery Disease/Ischemic Heart Disease

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3
Q

List the most common sites of atherosclerotic disease in the heart in increasing order

A

LAD > RCA > LCX > LCA

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4
Q

Distinguish a R. vs. L. dominant heart

A

R. Dominant - Posterior descending artery is supplied by R. coronary A.

L. Dominant - Posterior descending artery is supplied by L. circumflex A

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5
Q

Substernal chest pain (crushing, stabbing, squeexing); pain that radiates to neck jaw or schoulder; Rapid, weak pulse; profuse sweating; nauseas & vomiting; dyspnea and discomfort are all classic clinical features of what?

A

Myocardial Infarction

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6
Q

Causes of Coronary Artery Disease

A

Atherosclerosis
Coronary artery emboli
Myocardial vessel inflammation (vasculitis)
Vessel spasm

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7
Q

What is the most sensitive and specific biomarkers of myocardial damage

A

Cardiac troponin T and I

They are proteins that regulate calcium mediated contraction of cardiac muscle

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8
Q

What proteins are used to determine myocardial damage but are not gold standard

A

Creatine kinase MB heterodimer - is sensitive but not specific for cardiac injury

Myoglobin - It is nonspecific for cardiac injury

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9
Q

elevation of cardiac enzymes in a typical assay is seen as early as _____, _____ returns to normal after 48 to 72 hours and troponin remains elevated for _____

A

3 hours
CK-MB
>5 days

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10
Q

Occlusion of the LAD causes infarction of what?

A

Apex, LV anterior wall & anterior 2/3 of septum

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11
Q

Occlusion of the circumflex A. causes infarction of what?

A

L. ventricular lateral wall

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12
Q

Occlusion of the RCA causes infarction of what?

A

RV, LV posterior wall, posterior 1/3 of septum

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13
Q

At what point are the following irreversible histologic changes seen in a MI seen:

  1. Slight waviness of fibers
  2. Very early coagulation necrosis and edema
  3. Coagulation necrosis increases with loss of nuclei, hypereosiniophilic
  4. Neutrophil infiltrate, yellow tan infarct
  5. Presence of Macrophages
  6. Scar tissue is being laid down
  7. Scarring complete and consists of a dense scar
A
  1. 30 mins - 4 hrs
  2. 4 hrs - 12 hrs
  3. 12 hrs - 24 hrs
  4. 1 - 3 days
  5. 3 days - 1 week
  6. 1-2 weeks
  7. 2 months
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14
Q

What is the time frame and characteristics of the early complications of an MI

A

First 24 hours

  • Life threatening arrhythmias (V fib)
  • Contractile/Cardiogenic Dysfunction (Shock)
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15
Q

What is the time frame and characteristics of the intermediate complications of an MI

A

2-4 days and up to 2 weeks

  • Rupture: free wall, septum and papillary muscles
  • Acute fibrinous pericarditis
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16
Q

What is the time frame and characteristics of the late complications of an MI

A

After 2 weeks

  • Chronic pericarditis (Dressler Syndrome)
  • Ventricular aneurysm
  • Continued risk of heart failure and life threatening arrhythmia
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17
Q

What is the number one cause of death due to an MI & when does it typically occur

A

Arrhythmias, specifically ventricular fibrillation w/in 1 hour of onset

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18
Q

What is it called when there’s a rupture of the free wall, leading to blood accumulation in the pericardial space. This makes it hard for the heart to adequately fill during diastole because of the pressure of the blood in the pericardial sac and can ultimately lead to hemodynamic collapse

A

Acute pericardial tamponade

19
Q

Increase age, first MI, absence of LV hypertrophy are all risk factors for what

A

Myocardial rupture - transmural infarct 2-4 post MI

20
Q

What is Dressler Syndrome & it’s symptoms

A

Chronic fibrinous pericarditis due to immune reaction to myocardial proteins in blood.

Symptoms include fever, pleuritic pain, pericardial effusion

21
Q

What is Chronic ischemic heart disease (IHD)

A

A state of heart dysfunction as a result of late complication of a MI which can lead to congestive heart failure and sudden cardiac death

22
Q

Transient, often recurrent chest pain induced by myocardial ischemia but insufficient to induce myocardial infarction is known as what

A

Angina Pectoris

23
Q

What are the three clinical variants of Angina

A
  1. Stable Angina
  2. Prinzmetal Variant Angina
  3. Unstable Angina
24
Q

What causes the pain in Angina Pectoris

A

Lack of oxygen to tissues leads to the release of adenosine and bradykinin causing pain

25
Q 
Stable angina is characterized by:
Stenotic occlusion of \_\_\_\_\_ arteries
- Clinical manifestations include \_\_\_\_\_\_\_
- Relieved by \_\_\_\_\_\_\_
- Induced by \_\_\_\_\_\_\_
A

Coronary arteries

  • Substernal pressure, squeezing, burning
  • Relieved by rest or vasodilators
  • Induced by physical activity
26
Q

_______ variant angina is characterized by:

  • Episodic _______
  • Relieved by _______
  • Unrelated to physical activity, HR or BP
A

Prinzmetal variant angina is characterized by:

  • Episodic coronary artery spasm
  • Relieved by vasodilators
  • Unrelated to physical activity, HR or BP
27
Q

Define unstable angina

A

Angina which is present at rest or angina that increases in frequency or duration (crescendo pattern)

28
Q

STEMI corresponds pathologically to what

A

Transmural infarction (All layers of heart) & ST elevation in EKG

29
Q

Since NSTEMI and unstable angina both cause partial occlusion of coronary vessels, how can they be distinguished?

A

Presence or absence of troponin. If present then it’s an NSTEMI

30
Q

What is the second most common cause of death in car crashes

A

Aortic rupture - Typically at weaker points in aorta where the pulmonary artery is tethered by the ligamentum arteriosum

31
Q

What is the most common cause of arrhytmias & what do the other factors have in common

A

Ischemic heart disease/CAD

Almost any structural alteration can result in a conduction abnormality

32
Q

What is it called when the SA node is unable to generate a high enough heart rate commensurate with physiologic needs leading to symptomatic bradycardia

A

Sick sinus syndrome

33
Q

What is the etiology of Atrial fibrillation & what are it’s risk

A

Independent and sporadic depolarization of myocytes with variable transmission to the AV node. This leads to a irregular contractile pattern.

The ineffective pumping of blood causes stasis which can lead to clotting and thrombus formation

34
Q

What is the most common cause of sudden death after exertion

A

Long QT syndrome –> Torsades de pointes

35
Q

What is the most common cause of sudden death due to ischemia induced arrhythmia & what are the risk factors in younger patients?

A

Coronary artery disease

  • Drug abuse (cocaine, methamphetamine)
  • Hereditary conduction abnormalities
  • Hypertrophic or dilated cardiomyopathy
  • Myocardial hypertrophy
  • Myocarditis
  • Mitral valve prolapse
36
Q

Distinguish between systolic and diastolic dysfunction

A

systolic dysfunction - Increased oxygen demand

Diastolic dysfunction - Inability to relax heart muscles

37
Q

Systolic dysfunction leading to heart failure has to do with what?

A

Lack of pumping ability leading to decreased ejection fraction

38
Q

What are some causes of systolic heart failure

A
  1. Ischemic heart disease - Decreased cardiomyocytes causes the heart to not be able to pump as strongly
  2. Hypertension & Aortic stenosis - Ischemic changes can cause the pump to not be functionally as effective against increased pressure over the long term
  3. Dilated cardiomyopathy - Ventricles are too dilated to pump well
  4. Severe mitral regurgitation
39
Q

Diastolic dysfunction leading to heart failure has to do with what?

A

Heart cannot adequately fill but ejection fraction can be normal - less filling means less blood being expelled

40
Q

What are some causes of diastolic heart failure

A
  1. Hypertension & Aortic stenosis - Concentric L. ventricular hypertrophy decreasing ventricular space
  2. Hypertrophic cardiomyopathy - Decreases ventricular space
  3. Restrictive cardiomyopathy (fibrosis) - Decreases compliance of cardiac muscles
41
Q

What are the clinical manifestations of Left heart failure

A
  1. Decreases tissue perfusion –> Decreased cerebral & renal perfusion
  2. Pulmonary congestion/edema - cough, crackles, wheezes, tachypnea
  3. Orthopnea
  4. Tachycardia
  5. Exertional dyspnea
  6. Cyanosis
  7. Paraoxysmal Nocturnal dyspnea
42
Q

What is the classic chest x-ray image finding & histologic sign for L. CHF

A

Kerley B lines on X-ray

Hemosiderin-laden macrophages (due to extravasated RBCs)

43
Q

What are the causes of R. heart failure

A
  1. Left heart failure

2. Cor pulmonale (lung disease/dysfunction) - any cause of pulmonary hypertension

44
Q

What are the clinical manifestations of R. heart failure

A
  • Liver & splenic congestion –> hepatosplenomegaly
  • Distended juglar veins
  • Effusions - peritonel, pleural & pericardial spaces
  • Edema
  • Extertional dyspnea

CPR II - EXAM 1 & 2 (4 decks)

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